Management of Asthma with Concurrent Allergic Rhinitis

Introduction to Asthma Management

The American Academy of Otolaryngology-Head and Neck Surgery recommends adding a leukotriene receptor antagonist (LTRA) for patients with poorly controlled asthma and concurrent allergic rhinitis despite high-dose inhaled corticosteroids (ICS) plus long-acting beta-agonist (LABA) 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery suggests that LTRAs are specifically recommended for patients with concurrent asthma and allergic rhinitis, providing a dual benefit for both conditions 1, 3
The American Journal of Respiratory and Critical Care Medicine indicates that Step 4 therapy, which includes the addition of an LTRA, is warranted for patients with persistent symptoms post-exacerbation despite high-dose ICS plus LABA 4
Rhinology guidelines state that the combination of ICS with LTRA provides significantly greater efficacy in reducing airflow obstruction compared to doubling the ICS dose 5

The American Academy of Otolaryngology-Head and Neck Surgery recommends optimizing intranasal corticosteroids, as treatment of allergic rhinitis reduces bronchial hyperreactivity and improves asthma control 3
The American Journal of Respiratory and Critical Care Medicine suggests verifying adherence and technique, including checking inhaler technique and assessing medication adherence 7
The American Family Physician guidelines recommend reviewing the patient's action plan and ensuring they understand when to escalate therapy 8

The American Family Physician suggests reassessing the patient in 2-4 weeks to evaluate response to LTRA addition, checking symptom scores, peak flow measurements, and rescue medication use 8
The American Academy of Otolaryngology-Head and Neck Surgery recommends considering immunotherapy if combination pharmacotherapy fails to achieve control, as it can benefit both asthma and rhinitis 1, 3